Yupik Eskimo Diet and Obesity
Obesity and diabetes used to be virtually unknown among the Yupik Eskimos of southwest Alaska. Their traditional diet reflects their hunter-gatherer lifestyle: it consists mostly of meat, fish, berries, and a limited selection of greens and vegetables that grow wild on the tundra. Some Yupiks still eat a predominantly traditional diet, and have little trouble with obesity.
The infiltration of Western culture into this region has brought many changes, most of them good. Medical care is far more accessible; infant mortality rate and death from infectious disease are greatly reduced. Transportation and communication are much faster and easier. Availability of goods and services from outside the region is greatly improved. The arrival of the Western diet, however, has had deleterious effects on the health status of the Yupiks.
Western culture got its first modern-day toehold in this region about 150 years ago, with the arrival of the Moravian missionaries in the 1860s. For the first hundred years or so, the number of Caucasians was small enough to have little effect on the Yupik culture outside of the religious arena. Fifty years ago, the only noticeable effect of Western presence on diet was the addition of flour, sugar, and margarine, available from the white traders. Bread, either fried or baked, thickly spread with margarine and topped with sugar became the usual breakfast of many Yupiks.
In the 1950s, Bethel had a population of about 800 people, of which less than 20% were non-Native. Today Bethel’s population approaches 6,000, and half are non-Native. This influx represents a huge injection of Western culture in the region. From a dietary perspective, this means soda pop and candy in the grocery stores, and hamburgers and pizza in the restaurants.
The effects are felt in the villages as well as in Bethel. Almost every village has a store or trading post which sells canned and packaged foods which are ordered from the stores in Bethel or Anchorage. By far, the most-shipped item by weight is soda pop. Tons of it are shipped to the villages every year. It is not uncommon to find children who drink six or eight cans daily. Combined with candy and irregular tooth-brushing behaviors, the effect on their teeth is predictable. Many children here have full-mouth silver capping of their deciduous teeth, done in the OR under general anesthesia.
The other effect of so much sugar in the diet is obesity. It has practically exploded as an epidemic in the Yupik population in the last twenty years. Of course, sugar is not the only culprit. Pasta, rice and Crisco have also become staples of the Yupik diet.
Activity levels in daily life have also changed with the advance of Western culture. Snowmachines and four-wheelers have decreased the amount of walking that most people do, and there are far fewer dog teams to care for because of them. There is less need for chopping wood and hauling water with the advent of oil-burning stoves and indoor plumbing. Children’s entertainment more often involves television and video games than active physical activity.
The Yupik people as a whole tend to put on excess weight as truncal obesity—the classic “apple” shape. They refer to themselves as “top-heavy” when they are obese. A three hundred pound woman may be huge from shoulders to hips, but have relatively skinny arms and legs and practically no butt. When she sits, her pannus may come nearly to her knees. Overall, the Yupik are also fairly short people; average height for women is 60-62 inches, for men 64-66 inches.
One of the strategies for making inroads into the obesity epidemic among the Yupik is to encourage a return to traditional culture. “Stop eating Western junk food, you weren’t made for it; eat your traditional diet,” is what we advise. There is a strong resurgence of pride in their culture going on, and many younger people want to focus on this. The difficulty is that their traditional diet is a lot more work to acquire. The grocery stores don’t sell moose, beaver, swan or salmonberries. Dried pasta, on the other hand, is cheap, light to pack and has a shelf-life of years.
The diabetes education team is working hard to bring home the message about the connection between obesity and diabetes. The team includes a registered dietician who helps people adapt ADA (American Diabetic Association) recommendations to the Native lifestyle. They have folks wearing pedometers and striving for “thirty actives minutes per day”. Bethel residents are encouraged to join Weight Watchers and to participate in the hospital’s Biggest Loser program.
In short, the obesity epidemic which is overtaking Americans is not limited to the lower 48 or to the non-Native populations. An endless supply of cheap food which is always available, combined with decreased activity levels overall, has gradually fattened us as a nation. A tendency to turn to food for comfort in times of stress, isolation or despondency contributes to the fattening in the high-stress times we live in. The bottom line is as simple as it is difficult. Eat less. Exercise more. And curse your genes if you come from a long line of fat people.
Labels: Bush Medicine